Brown et al developed a model for predicting acute renal insufficiency after cardiac surgery. This can help to identify a patient who may benefit from more aggressive management. The authors are from the Northern New England Cardiovascular Disease Study Group (NNESDSG).
Patient selection: patient undergoing cardiac surgery with eGFR > 60 mL per minute per 1.73 square meter by the MDRD score
Outcome: renal insufficiency (eGFR < 30 mL per minute per 1.73 square meter)
Parameters:
(1) age of the patient in years
(2) gender
(3) diabetes mellitus
(4) WBC count per µL prior to surgery
(5) history of prior CABG
(6) congestive heart failure (CHF)
(7) peripheral vascular disease (PVD)
(8) hypertension
(9) preoperative intra-aortic balloon pump (IABP)
|
Parameter |
Finding |
Points |
|
age in years |
< 70 years |
0 |
|
|
70 to 74 years |
1.5 |
|
|
75 to 79 years |
2.0 |
|
|
>= 80 years |
2.5 |
|
gender |
male |
0 |
|
|
female |
1.5 |
|
diabetes mellitus |
no |
0 |
|
|
yes |
1.5 |
|
WBC count |
<= 12,000 per µL |
0 |
|
|
> 12,000 per µL |
1.5 |
|
history of previous CABG |
no |
0 |
|
|
yes |
2 |
|
congestive heart failure |
no |
0 |
|
|
yes |
2.5 |
|
peripheral vascular diease |
no |
0 |
|
|
yes |
1.5 |
|
hypertension |
no |
0 |
|
|
yes |
1.5 |
|
preoperative use of IABP |
no |
0 |
|
|
yes |
3.0 |
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 17.5
• The higher the score the greater the risk of severe renal insufficiency.
|
Score |
Percent Severe Renal Insufficiency |
|
0 to 5 |
(0.4943 * (score)) + 0.01429 |
|
5 to 10 |
(0.4429 * ((score)^2)) – (4.506 * (score)) + 14.68 |
|
>10 |
> 15% |
Performance:
• The area under the ROC curve was 0.72.
Specialty: Nephrology, Clinical Laboratory
